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Diastole: 4 aspects: 1. The heart is at rest and the myocardium is relaxed. 2. The atria and ventricles passively fill. AV valves allow blood to pass 3. The aortic and pulmonary artery semilunar valves are closed because the blood in those vessels is at a higher pressure than the ventricles. 4. Blood continues to fill atria and ventricles, stretching the compliant heart cells. Systole: 4 aspects: 1. The atria contract and eject the final amount of blood into the ventricles. 2. Atria relaxation causes atrial pressure to be lower than ventricular pressure. 3. High ventricular pressure relative to the atria causes the AV valves to close, preventing backflow while the ventricles contract. 4. The ventricles continue to contract, ejecting blood through the semilunar valves out to the lungs and rest of the body. CVP (Central Venous Pressure): The pressure of blood within the right atrium. Used to approximate the right ventricular end diastolic pressure (RVEDP) Normal = 2-6 mmHg High=overhydration, increased venous return or right sided cardiac failure. Low=hypovolemia or decreased venous return Right Ventricular End Diastolic Pressure (RVEDP): Assesses right ventricular function and general fluid status. Measured by CVP. CO (Cardiac Output): The volume of blood pumped by the heart in one minute. Normal=4-8 L/min High=high circulating volume Low=a decrease in circulating volume or a decrease in the strength of ventricular contraction. CI (Cardiac Index): Cardiac output (CO) divided by meter square of body surface area. Normal = 2.5-4 L/min/m2 Afterload: The resistance that the heart has to overcome, during every beat, to send blood into the aorta. These resistive forces include vasoactivity and blood viscosity. Mean Arterial Pressure (MAP): Reflects changes in the relationship between cardiac output (CO) and systemic vascular resistance (SVR). Reflects the arterial pressure in the vessels perfusing organs. Normal = 70-100 mmHg PA (Pulmonary Artery Pressure): Blood pressure in the pulmonary artery. Increased pulmonary artery pressure may indicate: a left-to-right cardiac shunt, pulmonary artery hypertension, COPD or emphysema, pulmonary embolus, pulmonary edema, left ventricular failure. Normal = Systolic 20-30 mmHg (PASystolic); Diastolic 8-12 mmHg (PADiastolic ), Mean 25 mmHg (MAD)
or pulmonary vasculitis. CHF. vasodilators. hyperthermia. pulmonary embolism. or late septic shock. Measured in ml/beat. Increased SVI may indicate of early septic shock. beta blockers. Normal = 25-45 mL/m2 Systemic Vascular Resistance (SVR): Measurement of resistance or impediment of the systemic vascular bed to blood flow. or isoproterenol or by the delivery of O2. or hypoxia. Increased PVR or "Pulmonary Hypertension" caused by pulmonary vascular disease. or digitalis. Increased SV may be caused by an increase in circulating volume or an increase in inotropy Normal = 50-100 mL Stroke Index or Stroke Volume Index (SI or SVI): Amount of blood ejected from the heart in one cardiac cycle. right ventricle failure. High RV pressure may indicate: pulmonary hypertension. aminophylline. mitral valve pathology. relative to Body Surface Area (BSA). Decreased SVR can be caused by early septic shock.Pulmonary Capillary Wedge Pressure (PCWP or PAWP): PCWP pressures are used to approximate LVEDP (left ventricular end diastolic pressure). High PCWP may indicate left ventricle failure. or hypercarbia Normal = 800-1200 dynes/sec/cm2 2 . and cardiac compression post hemorrhage. Decreased SV may indicate impaired cardiac contractility or valve dysfunction and may result in heart failure. morphine. nitrates. or an MI. Normal = Systolic-20-30 mmHg Diastolic 0-5 mmHg Stroke Volume (SV): Amount of blood pumped by the heart per cardiac cycle. late septic shock. Normal = 37-250 dynes/sec/cm2 Right Ventricular Pressure (RV Pressure): Direct measurement that indicates right ventricular function and general fluid status. Decreased PVR caused by medications such as calcium channel blockers. hypervolemia or be caused by medications such as dopamine. hypovolemia. Increased SVR can be caused by vasoconstrictors. Decreased SVI may be caused by CHF. cardiac insufficiency. Normal = 4-12 mmHg Pulmonary Vascular Resistance (PVR): Measurement of resistance or the impediment of the pulmonary vascular bed to blood flow. dobutamine. It is measured in ml per meter square per beat.